Provider Demographics
NPI:1184873549
Name:ELLINGTON, ROSINA IBETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ROSINA
Middle Name:IBETH
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:165 COTTONBELLE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9146
Mailing Address - Country:US
Mailing Address - Phone:770-389-7127
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-719-7256
Practice Address - Fax:770-719-7378
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186595363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA595097960AMedicaid
GA511I500695Medicare PIN